Provider Demographics
NPI:1245469097
Name:HYDE COUNTY DSS MATTAMUSKEET OPPORTUNTIES ADAP CENTER
Entity type:Organization
Organization Name:HYDE COUNTY DSS MATTAMUSKEET OPPORTUNTIES ADAP CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-926-4476
Mailing Address - Street 1:1430 MAIN ST
Mailing Address - Street 2:P O BOX 220
Mailing Address - City:SWANQUARTER
Mailing Address - State:NC
Mailing Address - Zip Code:27885-9760
Mailing Address - Country:US
Mailing Address - Phone:252-926-4476
Mailing Address - Fax:252-926-3711
Practice Address - Street 1:69 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NC
Practice Address - Zip Code:27826-9566
Practice Address - Country:US
Practice Address - Phone:252-542-9249
Practice Address - Fax:252-926-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL048005251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services